Surveillance for Recurrent Stenosis After Endovascular Procedures

Abstract

Eighty-nine endovascular procedures were performed during a 1-year period. Techniques included balloon angioplasty (n = 50), laser-assisted balloon angioplasty (n = 32), and atherectomy (n = 7). Indications were claudication (65.2%), critical ischemia (30.3%), and failing bypass (4.5%). Preoperative evaluation included a history and physical examination, segmental limb pressures, and color duplex ultrasonography. Postoperative surveillance consisted of a history and physical examination, ankle-arm indexes, and color duplex examinations at 1-week, 1-month, and then 3-month intervals. All levels of aortoiliac and infrainguinal disease were treated. Immediate technical success rate was 89.8%. Recurrence rates by life-table analysis reveal a 9-month patency rate of 45.4%. Early results of this prospective study indicate that endovascular procedures are subject to significant restenosis rates. Restraint is advised concerning general acceptance of endovascular procedures pending critical study.

Incidence, time-of-onset, and anatomical distribution of recurrent stenoses after remote endarterectomy in superficial femoral artery occlusive disease

“…These findings are similar to those of other investigators, who studied the value of duplex scanning compared with repeated clinical and hemodynamic evaluation. 11,[34][35][36] They concluded that clinical assessment and ABI measurements have been shown to be relatively insensitive, because many preocclusive lesions develop in the absence of significant clinical signs or hemodynamic changes. Some of the most important questions still to be answered are can we identify patients with recurrent stenoses after remote endarterectomy amenable for revision and does revision indeed improve long-term patency results and at what cost?…”

Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease

“…The iliac artery was deemed patent if a peak-systolic-velocity ratio of less than 2•5 was found at duplex ultrasonography. [17][18][19] We defined the primary endpoint of the study as no improvement or a worsening of the clinical category compared with the preprocedural clinical assessment. If we found a discrepancy between clinical symptoms and objective criteria of the treadmill-exercise test (ie, ABI, walking distance), we gave clinical symptoms precedence when assigning the category.…”

“…If we found a discrepancy between clinical symptoms and objective criteria of the treadmill-exercise test (ie, ABI, walking distance), we gave clinical symptoms precedence when assigning the category. 4 Secondary endpoints of interest were cessation of the study protocol owing to the complications of the intervention; postprocedural pressure gradient greater than 10 mm Hg across the treated site; restenosis diagnosed by colour duplex ultrasonography and defined as a peak-systolic-velocity-ratio greater than 2•5; [17][18][19] ABI improvement of less than 0•10 or deterioration by more than 0•15 compared with the maximum postprocedural value at 3 months; and repeated intervention at the treated site.…”

Noninvasive evaluation before and after percutaneous therapy of iliac artery stenoses: The value of the Bernoulli-predicted pressure gradient

“…8 Duplex scanning (PSV ratio) is the best noninvasive method to quantify iliac artery stenosis and has been suggested as a follow-up method after PTA or stenting. [9][10][11] A Bernoulli-predicted pressure gradient by means of duplex scanning velocity data might be another method in the noninvasive hemodynamic evaluation of endovascular therapy. The purpose of this study is to clarify the value of the Bernoulli-predicted pressure gradient in the noninvasive hemodynamic assessment of patients undergoing PTA or stenting of iliac artery stenosis.…”